Cefepime vs Piperacillin- Tazobactam in Adults Hospitalized With Acute Infection

16 Oct 2023 • Does the choice between cefepime and piperacillin-tazobactam affect the risks of acute kidney injury or neurological dysfunction in adults hospitalized with acute infection? Although piperacillin-tazobactam has been hypothesized to cause acute kidney injury and cefepime has been hypothesized to cause neurological dysfunction, their comparative safety has not been evaluated.

The Antibiotic Choice on Renal Outcomes (ACORN) randomized clinical trial compared cefepime vs piperacillin-tazobactam in adults for whom a clinician initiated an order for antipseudomonal antibiotics within 12 hours of presentation to the hospital in the emergency department or medical intensive care unit.


  • Among 2511 adults hospitalized with acute infection, the highest stage of acute kidney injury or death was not significantly different between patients randomized to cefepime and those randomized to piperacillin-tazobactam. Patients randomized to cefepime experienced more neurological dysfunction, a secondary outcome.


  • Among hospitalized adults, the risk of acute kidney injury did not differ between cefepime and piperacillin-tazobactam, but neurological dysfunction was more common with cefepime.
  • Patients in the cefepime group experienced fewer days alive and free of delirium and coma than patients in the piperacillin-tazobactam group.

Source: JAMA | Read full story

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